Steep Rise in Deaths for People Hospitalized After Opioid OD
MONDAY, Dec. 4, 2017 -- The death rate has quadrupled among people whose opioid use lands them in a hospital, a new U.S. study finds.
More opioid users are being sent to the hospital due to a life-threatening overdose than for treatment of drug addiction, the researchers noted.
About 2 percent of people hospitalized for opioid use died in 2014, compared with 0.4 percent prior to 2000, the new analysis of federal hospital data revealed.
The same analysis showed that hospitalizations due to opioid or heroin poisoning have increased in recent years, even as the rate of people seeking treatment of opioid addiction at a hospital has gone down, said senior researcher Dr. Zirui Song. He is an assistant professor of health care policy at Harvard Medical School.
Before the turn of the century, most opioid-related hospitalizations were for treatment of opioid dependence and abuse. The more dire condition of drug overdose now has taken over as the major cause of opioid-driven hospital admissions, Song said.
"You can see that primary diagnoses due to dependence or abuse gradually goes down, while primary diagnoses of opioid and heroin poisoning steadily goes up," he noted.
Patients admitted for opioid or heroin overdose are also more likely to be white, middle-aged, from a lower-income area or being treated for a disability, according to Song's analysis of the nation's largest hospital inpatient database.
One health policy expert found the findings troubling.
"The opioid crisis has caught up people who haven't been traditionally involved up in heroin crises in the history of our country," said Emily Feinstein, director of health law and policy for the National Center on Addiction and Substance Abuse.
"Studies have been telling us that middle-aged white Americans are dying sooner," Feinstein added. "We think this is a lot because of substance abuse, and this study confirms that. We're seeing opioid abuse partly driving that trend."
An estimated 91 Americans die every day from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention. More than 64,000 overdose deaths occurred in 2016, including more than 15,000 deaths from heroin and more than 20,000 due to synthetic opioids.
Song's observations confirm what experts had suspected about the progression of America's opioid epidemic, which was sparked by increasing numbers of Americans gaining access to and becoming hooked on prescription painkillers, Feinstein said.
"We know what kicks this off is the misuse of prescribed opioids, but we also know this is not really driving the problem anymore," Feinstein said.
The initial response to the opioid epidemic restricted access to prescription drugs, but didn't address the underlying issue of drug addiction, Feinstein explained.
Drug users are probably suffering overdose deaths more frequently because they switched from prescription painkillers to more potent and more easily obtainable opioids such as heroin and fentanyl, Feinstein and Song said.
"Heroin and especially fentanyl, which is an even stronger form of opioid, present higher risks of overdose than conventional opioid pills," Song said.
Fentanyl can be 50 to 100 times more potent than heroin, and often is cut into street heroin or illicit pain pills without the users' knowledge, said Dr. Tim Brennan, an attending physician with The Addiction Institute at the Icahn School of Medicine at Mount Sinai in New York City.
"Many more people are now coming into the hospital because they've been accidentally poisoned by their drug of choice," Brennan said. "You think you're buying heroin, but more and more heroin is adulterated by fentanyl, which makes it much more dangerous. Not only are more people using this product than ever before, but the product is more dangerous than ever before."
However, another explanation is possible. More people might be getting community-based treatment for drug addiction, which means it's more likely they'll only wind up hospitalized for an overdose, Song said.
"If you assume for a moment that lower severity cases can be immediately treated in the community or home or street setting, then on average the people who end up in the hospital may, on average, be sicker," Song said.
The analysis also cannot account for people who might be dying of overdose out in the community, Song added.
Ultimately, these numbers show that addiction treatment remains woefully underfunded, Feinstein said.
"We need immediate broad-reaching investments in good treatment. When people experience an overdose, at that moment they should be going into treatment rather than released back into the community as if they don't have a deadly illness," Feinstein said. "Not enough is done. We could be preventing these deaths."
The study was published in the December issue of Health Affairs.
For more on the opioid epidemic, visit the U.S. Centers for Disease Control and Prevention.
Posted: December 2017